Karsan, Yasmin
(2021)
Exploring the potential roles and services of the community pharmacy team during a time of healthcare reform.
PhD thesis, University of Nottingham.
Abstract
Globally, health systems are complex and dynamic and can face issues when attempting to deliver equitable, accessible healthcare. Much of this is due to lack of integration across care providers. The National Health Service in the United Kingdom has revolutionised healthcare as we know it today. Currently, the NHS can be perceived as significantly fragmented, with many care providers delivering services in duplication.
Primary care is the gateway between care in the community and hospitalisation. Ninety percent of patient contact occurs within this care setting, as it mainly delivers services outside the hospital setting. Therefore, providing many channels for access to healthcare for the predominant proportion of the population.
One criticism of community care is the disconnect between care providers, which can lead to resource waste and weak outcomes, in association with care provision. One way to decrease this fragmentation is to develop an integrated approach across care providers, to facilitate seamless care delivery to strengthen primary care provision.
This study focusses on the Five Year Forward View. The publication demonstrates the requirements of the significant efficiencies and financial drivers needed to sustain and improve service provision. This would be achieved through developing new models of care to link up fragmented care through integration.
Community pharmacy is an integral care provider to support primary and community care provision. The aim of this study is to explore the potential roles and services of the community pharmacy team within a dynamic complex healthcare system.
This study consists of using a multiple case study methodology to explore the role of the community pharmacy team within the new models of care. In order to investigate this topic, semi-structured interviews and observations were undertaken to provide key insights and understandings of the identified case study sites. Three case studies were identified as part of the new models of care program. Twenty-two stakeholders were interviewed (health service commissioners (2), pharmacy team members (7), pharmacy leaders (3), Chief pharmacist (1), pharmacy business specialists (3), allied healthcare professionals (4), non-healthcare primary care professionals (2). Participants were purposefully sampled through snowballing, in order to directly access those stakeholders involved in the new models of care. Inclusion criteria consisted of having direct involvement with pharmacy related to the Five Year Forward View new models of care program. Interviews were transcribed verbatim and thematically analysed using NVivo® 11 software. The analysis process consisted of a two-stage process of inductive thematic analysis and deductive theoretical mapping on to Open Systems Theory.
This investigation leads to the identification and formation of the Formed Integrated Care System. This is key to the provision of sustaining efficient, accessible healthcare services within a complex dynamic health system. The results from this study suggest, attributes such as seamless care provision, workforce and training are critical to the development and sustainability of the Formed Integrated Care System.
Pharmacy teams play strong roles in any integrated care system, in particular, in the community setting. Findings from this study demonstrate there are key roles for the community pharmacy team to deliver services. However, the depth of integration of these services within the wider system are significantly reliant on relationships. Two key requirements underpinned the community pharmacy teams initial integration within the wider integrated care system, these are identity and training.
This study indicates community pharmacy teams play an essential role in community care provision. Their position in the community presents them as gatekeepers to accessing healthcare services, providing them with an opportunity to facilitate better service provision. Within the wider healthcare system, the identity of community pharmacy is presented to be variable and therefore, defined roles and responsibilities for community pharmacy need to be clarified, in order for its place within an integrated care system to be recognised.
Implications for practice consist of a ‘whole system’ approach to integrated care provision, which includes a strong community pharmacy component. Due to the current COVID-19 pandemic, key factors which have been highlighted in this study may have altered in importance. Therefore, it is essential to research which factors, identified in this study, have been enhanced in order to support healthcare delivery during and post-COVID-19. This will be vital to understand as it will set the pathway for community pharmacy provision for the future.
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